Health Care Technology and Patient Care

Health care technology has exploded over the last 10-20 years, not just in the arena of medical diagnosis and treatment, but also in the area of health information and documentation technology.

We now have the ability to look up almost any aspect of medical information we need at the touch of a button. We almost don’t even need textbooks any longer. The ability to research journals, textbooks, university libraries, even the Library of Congress online is unprecedented.

Developing office websites and blogs has become much easier for physicians and other non-computer-savvy health care workers as a means of communicating with patients and even helping to draw patients into their practices. A web-development and hosting company like Solo Build It made it possible for me to design and publish this site. All I had to do was write the content and use the tools they gave me to do the rest.

Documentation and management of patient records has been somewhat slower, but nevertheless, progressing fairly rapidly now in recent years.

With the progression of health care technology over the last decade, particularly with regard to the electronic medical record (EMR), we have seen many benefits to patient care including improvements in documentation, better legibility of chart notes and prescriptions, improvements in awareness of drug interactions, more attention to preventive health care and improved tracking of test results, and scheduling of follow up visits and future testing, to name a few.

Unfortunately, however, as with anything else in life there are always downsides…

Safety concerns

As we implement these new, but long overdue, health care technologies, the software in many cases still seems to lag behind what is needed to prevent pitfalls and safety issues. Order entry must be done very carefully to avoid errors. It’s too easy to overlook the presence or absence of checkmarks in boxes on a complicated computer screen.

It’s difficult to find the important information amidst all the unimportant verbiage. Again, it’s too easy to overlook the important things.

Maintenance of accurate medication lists continues to be a challenge. “Garbage in = Garbage out”.

Inefficiencies

Again, sometimes, it’s very difficult to find the information you need in a concise form for adequate patient care. You may have to look in five different screens to get the lab data, xray results, review the previous notes, find the nurses notes , review the physical therapy report, the medication list, etc., etc. before you go see the patient, then come back and review it all again to be sure you’re not missing something before you type a note. I’ve seen some doctors having to keep their own written notes as they are reviewing the electronic chart in order to assimilate the information and allow their minds to put it together to form a plan of care. Workflow is haphazard and non-intuitive with many of these systems. It may take 4-5 clicks to change someone’s diet order.

Medico-legal concerns

• There is too much information to wade through to find the important stuff, as mentioned above.

• Notes from nurses, physical therapists, technologists and others are often difficult to find and decipher as you look through a myriad of checkboxes.

• Templates, which don’t fit the patient are often found in these electronic records. For example, because of the common practice of using these templates to fill in progress notes or physicals, many of which are repetitive, it is not unusual to find a report of a prostate exam documented on a female’s record, or a pelvic exam on a male’s record or a “normal” neuro exam on a patient who’s had a severe stroke, or a “normal heart rhythm on a patient with chronic atrial fibrillation. Malpractice attorneys will have a field day with notes like this. Defendants will have a hard time proving their credibility to a jury in these situations.

• Computerization of patient records using the new electronic health care technology will soon become the standard of care. Those offices or institutions that don’t comply will be at risk if something goes wrong that may have been prevented if the records had been computerized.

Reimbursement for medical care will soon become dependent on the use of health care technology for electronic billing. Written insurance forms will no longer be accepted. Medicare appears to be leading the way on this. Other insurers will surely follow. In addition, the level of reimbursement for a particular diagnosis may become dependent on Pay-for-Performance issues, which may be easier to track on computerized records.

Further depersonalization of the doctor-patient relationship may be difficult to avoid. In many cases, the use of the electronic medical record (EMR), is becoming an end unto itself. Doctors and nurses are finding themselves treating the computer rather than the patient. This is very easy to do, especially when the EMR is first implemented into the practice or institution. The patients need the same care as before, but the care providers are spending so much time trying to enter their notes or their orders that patients don’t get the care they need. This leads to greater malpractice risk.

Steep Learning Curves

Some EMR’s have very steep learning curves and are very rigid and nonconforming, especially the ones adopted by large institutions. They are often designed as one-size-fits-all programs, the concept of which never works for real patient care. Their rigidity and poor configurability create frustrations and inefficiencies. Computer programmers, who have little or no knowledge of patient care, or physician or nurse workflow, have written many of these programs.

Selection of the right program for your particular practice along with proper training for the physicians and staff become critical factors in quickly developing the ability to use the electronic health care technology effectively so that you can maintain or resume personalized attention to your patients with little or no transitional effect.

Expense

At a time when reimbursement keeps getting lower for doctors’ offices and expenses keep going higher, now they are required to pay thousands of dollars for new health care technology that in many ways further reduces efficiency, may actually increase errors if they are not very careful, reduces contact with patients and adds another dimension to the so-called “hassle-factor” that is already causing tremendous frustration for doctors as they attempt to provide high quality patient care. Is it any wonder that health care technology is so slow to be accepted in many doctors’ offices?

Nevertheless, the benefits probably do far outweigh the disadvantages in most cases. This just represents another challenge to overcome. Hopefully as the technology improves, it will become more streamlined and easier to work with and actually result in some measurable improvements in patient and provider satisfaction. For now, we will have to live with some of the "growing pains" of high-tech documentation. Most importantly, we must continually strive to be sure patients do not suffer in the process.